Common Painkillers ‘Do More Harm Than Good’ for Chronic Pain

Common Painkillers ‘do more harm than good’ for Chronic Primary Pain according to new draft guidance published by the NHS & NICE.

Senior NHS officials disclose that aspirin, ibuprofen, paracetamol and opioids are all unsuitable for chronic primary pain.

Painkillers that are commonly recommended by doctors and sold over the counter in pharmacies and supermarkets. Drugs such as ibuprofen, aspirin, paracetamol and opioids can cause “more harm than good” and should not be prescribed by doctors to treat chronic primary pain. A statement made by health officials has said. 

The National Institute for Health and Care Excellence (NICE) said that there was “little or no evidence” that commonly used drugs for chronic pain improved people’s quality of life, pain or psychological distress. The guidance said that there was evidence that the painkillers can cause harm, particularly addiction. Prescribing drugs that can cause the patient to become addicted is obviously undesirable as it increases the sufferer’s burden rather than improving their daily life.

Chronic primary pain cannot be accounted for by a typical diagnosis and it will be interesting to see whether NICE have guidance on other Chronic Pain conditions such as Fibromyalgia, Arthritis & Rheumatoid Arthritis. Chronic primary pain causing great emotional distress and limits a sufferer’s mobility. The pain can be widespread and even chronic musculoskeletal pain in some cases.

This guidance will help doctors decide upon the most appropriate treatment for patients. Chronic Pain conditions are very specific to each patient and it can be a complex task to find the ideal treatment for patients. There is an expectation from many patients for a doctor to be able to prescribe something that can eradicate the pain. The options that are successful in preventing pain can have detrimental long-term side effects and as the recent NICE guidance suggests the drugs can do more harm than good. This clearer understanding of the evidence for the effectiveness of treatment of chronic pain should lead to an improvement of the confidence of doctors in their conversations with their patients.

NICE declared that approximately 30-50% of the population may be affected by chronic pain and almost 50% of people with chronic pain also have a diagnosis of depressions. While 66% of sufferers are unable to maintain full time employment due to their condition. 

The NICE guidance seems to suggest that patients should be offered alternative treatments and therapies. Supervised group exercise programmes are one example of an alternative therapy that could help patients deal with their chronic conditions. Forms of psychological therapy are another alternative, this may help those dealing with chronic pain to find coping strategies and discover methods to manage their pain. Acupuncture was also mentioned within the guidance.

The NICE guidance did also disclose that some antidepressants should be considered for people dealing with chronic primary pain.

The guidance stated that paracetamol, anti-inflammatory drugs such as aspirin and ibuprofen or opioids should not be offered to patients because there was little or no evidence at all to prove that these drugs made any improvement to people’s pain, quality of life or their psychological distress. However, there was evidence that these drugs can cause harm to the user and can even cause addiction.

The drafted NICE guidelines also revealed that anti-epileptic medication such as ketamine, corticosteroids, anti-psychotics and gabapentinoids should not be prescribed to patients to manage chronic primary pain as there was little or no evidence concerning the efficacy of these medications.

Ineffective treatments can be extremely disheartening for patients and it is imperative that there is an understanding about how pain disrupts a person’s life and their family. Understanding this should be the first step in providing treatment and deciding upon the best course of action and developing an effective care plan.

While the draft guidance does provide numerous findings about drugs used to manage pain, there is still a tremendous amount of research that needs to be carried out to assess the range of possible treatment options. 

There is an immediate need for an alternative option for doctors and patients. The alternatives must have significantly less serious side effects and no long-lasting negative impact. Cost is also a factor as paracetamol and ibuprofen are quite cheap. The instant relief provided by the drugs that replace paracetamol, ibuprofen and aspirin need to provide an almost instant relief from pain to allow sufferers to manage their pain.